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Re: Type II diabetes in a 13 year old caucasian girl

I read with interest the recent paper on "Pancreatic dysfunction in severe obesity" by Drake et al where they identified one obese Caucasian adolescent with type II diabetes.[1] All previously reported cases of Type II diabetes in adolescents in the United Kingdom have been amongst ethnic minority groups especially Asian patients.[2][3] I wish to report another case of type II diabetes in a young British Caucasian girl.

AJ presented at the age of 13 years. She was asymptomatic but was referred because a random blood sugar done by the GP was found to be elevated at 12.9mmol/L. She was obese, BMI 36 (>99.6th centile for age), not dysmorphic, no Acanthosis Nigricans, and normotensive. She was known to have undergone valvotomy for pulmonary stenosis but was not on any medication. Her mother had type II diabetes diagnosed at the age of 27 years.

Investigations showed hyperglycaemia with hyperinsulinaemia
Fasting blood sugar: 11.1 mmol/L
Fasting C peptide: 2198 pmol/L
Fasting insulin: 553.0 pmol/L
Fasting Pro-insulin: 177 pmol/l (normal <10 pmol/l)
Islet cell antibody screen was negative
Normal fasting cholesterol and triglycerides
Her pre-meal blood sugar profile during the day was between 7.9 - 14 mmol/L.

Management consisted of encouraging change in lifestyle with emphasis on healthy eating and regular exercise. She continues to receive regular dietary advice. She was started on Metformin 500mg bd. Her blood sugar profile improved. Her current HbA1c after 3 months of therapy is 7.5%.

With increasing prevalence of obesity in all ethnic groups in this country, we may begin to see more cases of type II diabetes amongst the Caucasian population too. Risk factors appear to be the presence of obesity, Acanthosis Nigricans and family history of diabetes. Type I diabetes however, remains the commonest type of diabetes in the paediatric population.

Dr J C Agwu
Consultant Paediatrician
Sandwell Healthcare NHS Trust
West Bromwich B71 4HJ, UK References

(1) Drake AJ, Greenhalgh L, Newbury-Ecob R, et al, Pancreatic dysfunction in severe obesity. Arch Dis Child 2001;84:261-2.

(2) Etisham S, Barnett Y Gm Shaw N J. Type II diabetes Mellitus in UK Children - an energy problem. Diabet Med 2000;17(12):867-71.